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Variants in more than 60 different genes, most of which code for podocyte‐related proteins, have been found to be associated with monogenic forms of nephrotic syndrome (NS). Biallelic variants in DAAM2, a member of the formin family, were recently identified to cause autosomal recessive (AR) NS type 24 in four unrelated families with steroid‐resistant nephrotic syndrome (SRNS). This case report represents only the fifth reported family of DAAM2‐associated NS and the first from India, with two sibs who presented with a complex phenotype characterized by steroid‐resistant nephrotic syndrome, short stature, dysmorphic facial features, deep‐set toenails, myopia, increased thickness of the calvarium of the skull, and sloping ribs. Both sibs were found to have a homozygous likely pathogenic nonsense variant c.196C>T (p.Arg66Ter; NM_001201427.2) in exon 3 of the DAAM2 gene through whole exome sequencing. The dysmorphic features could possibly be part of the DAAM2‐related phenotype which has hitherto not been reported or could represent a blended phenotype, with the extrarenal manifestations resulting from a yet to be identified coexisting genetic condition. [ABSTRACT FROM AUTHOR]

Objective To present a new treatment for ingrown toenail with CO2 laser that is easy to perform, without damage the nail, nail matrix and nail bed. Methods A total of 21 ingrown toenail (IGT) lesions of the big toe in 16 patients who were diagnosed as ingrown toenail were treated with CO2 laser, while tissues along nail groove around the lesion was ablated, ingrown nail plate was exposed and separated. Results A total of 16 patients, with a mean age was (23.38 ± 13.61) years. All the 21 lesions were regressed except 2 with relapse (the cure rate was 90.48%). The time of return to walking, and return to daily activity were (2.25 ±0.66) days and (5.13 ± 0.86) days, respectively. During the 6-35 months follow-up, the cosmetic effect was remarkable with normal appearance and function. There were no complications. Conclusion Ingrown toenail can be surgically treated without matriceetomy and preserved the nail. All necrotic tissue and certain volume of soft tissue surrounding the lesion should be ablated to decompress the nail and reduce inflammation. [ABSTRACT FROM AUTHOR]

Partial great toe transfer is widely used in finger reconstruction. Although satisfactory results have been reported at the recipient's hand, the donor foot still presents with many problems due to the large amount of tissues harvested. In this study, the Ilizarov technique was utilized to enlarge the great toe in order to minimize the amount of tissue sacrificed of the donor foot. In this retrospective study, 23 patients (30 toes) underwent transverse distraction of the great toe for finger reconstruction from September 2020 to December 2022. The width of the contralateral normal finger was set as the objective width gained of distraction. At the last follow‐up, the changes of bone, toenail, plantar skin, vessel, and nerve of the great toe were measured, and postoperative complications were assessed. The time for active distraction was 46.1 ± 8.3 days, with a widening rate of 0.41 ± 0.08 mm/day. Counting in the time for latency and consolidation, the time of treatment with external fixation was 84 ± 11.9 days. At the last follow‐up, the average width of the distal phalanx of the great toe increased from 13.1 to 28.1 mm (p < 0.001). The width of the toenail increased from 15.8 to 30.3 mm (p < 0.001), and the width of the plantar pulp increased from 25.6 to 38.8 mm (p < 0.001). Computed tomography angiography (CTA) and Doppler ultrasound confirmed that the digital arteries and nerves of the great toe were intact after distraction surgery. Two patients needed revision surgery due to complications of pin loosening or premature consolidation. With the help of the Ilizarov technique, the great toe is effectively enlarged after transverse distraction. Multiple tissues of the great toe, including bone, nail, and plantar skin, are regenerated, and more tissues were preserved after toe‐to‐hand transfer. To the best of our knowledge, this is a novel method to enlarge the donor site for finger reconstruction. [ABSTRACT FROM AUTHOR]

Introduction: Efinaconazole 10% topical solution labeling for onychomycosis describes phase III trials of 12 months of treatment; the slow growth of onychomycotic nails suggests a longer treatment period may increase efficacy. We present here the first evaluation of extended use of efinaconazole 10% topical solution for up to 24 months. Materials and Methods: Enrolled patients (n = 101) had one target great toenail with mild to moderate distal lateral subungual onychomycosis and applied efinaconazole 10% topical solution to all affected toenails once daily for 18 months (EFN18) or 24 months (EFN24). Efficacy and safety were evaluated at each visit by visual review and mycology sampling. Results: Regarding the target toenail for patients treated for 24 months (EFN24), mycological cure (negative microscopy and culture) was 66.0% at Month 12, increasing to 71.7% at Month 24; effective cure (mycological cure and ≤10% affected nail) was 13.2% at Month 12, rising to 22.6% at Month 24. Mild to moderate application site reactions (symptoms of erythema/scaling) were the only efinaconazole-related reactions, in eight patients (7.9%). No systemic efinaconazole events or drug interactions were found. Patients aged 70 years or more had similar efficacy to younger patients at all time periods and did not show any increased treatment risks. Thinner nails exhibited better clearance versus thicker nails. A higher proportion of patients with Trichophyton mentagrophytes complex infection experienced application site reactions (35.7%), and a higher effective cure was found at Month 24 versus T. rubrum patients. Conclusion: There is a trend of increasing mycological cure and effective cure beyond Month 12 to Month 24, without an increased safety risk. The enrolled population in this trial was significantly older than in the phase III trials, with a greater degree of onychomycosis severity; however, increased age did not appear to reduce the chance of efficacy to Month 24 in this study. Our data suggest that lack of ability to clear nail dystrophy remains a significant problem for patients, rather than any lack of efinaconazole action over long-term treatment periods. [ABSTRACT FROM AUTHOR]

Prostate cancer is a common cancer among males in the US, but little is known about its risk factors, including trace elements. The primary aim of this study was to examine prostate cancer and its association with arsenic and selenium in toenails. We conducted a small, nested case-control study of men residing in Iowa within the Agricultural Health Study cohort, where we also collected toenail samples to test for arsenic and other trace elements. Toenail samples were sent for neutron activation analysis aimed at long-lived trace elements, including arsenic. Logistic regression was used to estimate odds ratios (ORs) for trace element exposures and prostate cancer. A total of 66 prostate cancer cases and 173 healthy controls returned questionnaires, over 99% of which included toenail samples. An increased risk was seen for the highest levels of arsenic (OR = 3.4 confidence interval (CI) of 1.3–8.6 and OR = 2.2, 95% CI of 0.9–5.6) and the highest level of selenium (2.0, 95% CI of 1.0–4.0). These data also show detectable levels of over 50% for 14 of 22 elements detected in the toenails. The association seen here with arsenic and prostate cancer further supports ecological studies finding an association with community levels of arsenic and prostate cancer incidence and mortality. [ABSTRACT FROM AUTHOR]

Introduction: Topical antifungals for toenail onychomycosis must penetrate the nail to deliver an inhibitory concentration of free drug to the site of infection. In two ex vivo experiments, we tested the ability of topical antifungals to inhibit growth of Trichophyton rubrum and Trichophyton mentagrophytes, the most common causative fungi in toenail onychomycosis. Methods: Seven topical antifungals were tested: three U.S. Food and Drug Administration-approved products indicated for onychomycosis (ciclopirox 8% lacquer; efinaconazole 10% solution; tavaborole 5% solution) and four over-the-counter (OTC) products for fungal infections (tolnaftate 1% and/or undecylenic acid 25% solutions). The ability to inhibit fungal growth was tested in the presence and absence of keratin. Products were applied either to human cadaverous nails or keratin-free cellulose disks prior to placement on an agar plate (radius: 85 mm) seeded with a clinical isolate of T. rubrum or T. mentagrophytes. After incubation, the zone of inhibition (ZI), defined as the radius of the area of no fungal growth, was recorded. Results: In the nail penetration assay, average ZIs for efinaconazole (T. rubrum: 82.1 mm; T. mentagrophytes: 63.8 mm) were significantly greater than those for tavaborole (63.5 mm; 39.1 mm), ciclopirox (7.4 mm; 3.6 mm) and all OTC products (range: 10.5–34.2 mm against both species; all P < 0.001). In the cellulose disk diffusion assay, efinaconazole and tavaborole demonstrated maximal antifungal activity against both species (ZIs = 85 mm); average ZIs against T. rubrum and T. mentagrophytes were smaller for ciclopirox (59.0 and 55.7 mm, respectively) and OTC products (range: 31.2–57.8 mm and 25.7–47.7 mm, respectively). Conclusions: Among all antifungals tested, the ability to penetrate human toenails to inhibit growth of both T. rubrum and T. mentagrophytes was greatest for efinaconazole, followed by tavaborole. These results indicate superior transungual penetration of efinaconazole compared to the other antifungals, suggesting lower keratin binding in the nail. [ABSTRACT FROM AUTHOR]

Objective: Patients with onychomycosis may use nail polish to camouflage affected nails, despite potential interactions between nail polish use and topical onychomycosis treatments. Our objective was to review available data on nail polish use concurrent with topical efinaconazole 10% solution for the treatment of onychomycosis. Methods: We conducted a PubMed search and narrative review of data on effects of nail polish on penetration of efinaconazole and clinical studies of efinaconazole in the treatment of toenail onychomycosis concurrent with nail polish use, including results of an investigator-initiated study of gel nail polish pedicures. Results: In vitro, penetration of efinaconazole through cadaverous nails coated with traditional nail polish was similar to penetration through uncoated nails. In a 52-week clinical study, efinaconazole treatment was associated with similar improvements in onychomycosis severity and clear toenail growth between participants who used traditional nail polish and those who did not use nail polish. In a second clinical study, participants received efinaconazole treatment concurrent with monthly gel nail polish pedicures. After 6 months, 100% of participants tested negative for fungal infection and all experienced visible improvements in treated toenails. Efinaconazole application was associated with degradation of traditional nail polish texture/appearance. In contrast, efinaconazole did not affect the duration, quality, or texture of gel polish. Limitations: Only four small studies have assessed nail penetration and efficacy of efinaconazole 10% solution with concurrent nail polish use. Conclusion: Efinaconazole 10% solution demonstrated efficacy in the treatment of toenail onychomycosis among participants concurrently using toenail polish, with no visible impact on gel-polished nails. [ABSTRACT FROM AUTHOR]

Background: Nearly 10% of all dermatological disorders and conditions are attributed to the disorders of the nails. Onychoscopy is beneficial in the diagnosis of nail conditions as well as for assessment of the progression, severity, and monitoring of the response to the therapy. Aim: The present study aimed to assess the dermoscopic and sociodemographic features in subjects with nail disorders and Onychoscopy of nail lesions in subjects with dermatological disorders. Methods: The present study assessed 88 subjects with nail disorders from both genders. There were 56.81% (n=50) males and 43.18% (n=38) females in the study. In all included subjects, dermoscopic and sociodemographic features were assessed. The data gathered were analyzed for results formulation. Results: The study results showed that fingernails were more commonly affected in 37.5% (n=33) subjects compared to toenails in 84.09% (n=74) subjects. The most common nail condition was Onychomycosis seen in 32.9% (n=29) subjects that showed findings of onycholysis with spikes and jagged edges in 68.9% (n=20), subungual hyperkeratosis in 72.41% (n=21) subjects, and 75.86% (n=22) subjects respectively. The next common condition was nail psoriasis seen in 18.1% (n=16) of study subjects depicting dilated globose nail fold vessels on capillaroscopy, and onycholysis. Conclusions: The present study concludes that onychoscopy can decrease the need for biopsy which is an invasive procedure by focusing on subtle changes and helps in excluding the differential diagnosis. Also, onychoscopy is a diagnostic choice in young children. The present study helped to assess connective tissue disorder severity and can help in diagnosing the benign nature of melanonychia. [ABSTRACT FROM AUTHOR]

Onychocryptosis, popularly known as "ingrown toenail", is defined as an inflammatory condition of the lateral nail fold resulting from the ingrowth of the lateral edge of the nail plate into the lateral nail fold, which occurs most frequently in the hallux. It is a reason for great demand for primary health care and is sometimes associated with disabling pain and, therefore, a frequent reason for absenteeism from work. Nail fold hypertrophy is a common consequence of onychocryptosis. Therefore, the present study reports an exuberant case of lateral nail fold hypertrophy treated surgically in a patient with chronic onychocryptosis. [ABSTRACT FROM AUTHOR]

Introduction: It has long been accepted that trauma is one of the most important and frequent predisposing factors for onychomycoses. However, the role of direct trauma in the pathogenesis of fungal nail infections has only recently been elucidated in a series of 32 cases of post-traumatic single-digit onychomycosis. The importance of repeated trauma due to foot and toe abnormalities was rarely investigated. Aimof the study: This is a multicenter single-author observational study over a period of 6 years performed at specialized nail clinics in three countries. All patient photographs taken by the author during this period were screened for toenail alterations, and all toe onychomycosis cases were checked for whether they contained enough information to evaluate potential foot and toe abnormalities. Particular attention was paid to the presence of hallux valgus, hallux valgus interphalangeus, hallux erectus, inward rotation of the big toe, and outward rotation of the little toe, as well as splay foot. Only cases with unequivocal proof of fungal nail infection by either histopathology, mycologic culture, or polymerase chain reaction (PCR) were accepted. Results: Of 1653 cases, 185 were onychomycoses, proven by mycologic culture, PCR, or histopathology. Of these, 179 involved at least one big toenail, and 6 affected one or more lesser toenails. Three patients consulted us for another toenail disease, and onychomycosis was diagnosed as a second disease. Eight patients had a pronounced tinea pedum. Relatively few patients had a normal big toe position (n = 9). Most of the cases had a mild to marked hallux valgus (HV) (105) and a hallux valgus interphalangeus (HVI) (143), while hallux erectus was observed in 43 patients, and the combination of HV and HVI was observed 83 times. Discussion: The very high percentage of foot and toe deformations was surprising. It may be hypothesized that this is not only a pathogenetically important factor but may also play an important role in the localization of the fungal infection, as no marked hallux deviation was noted in onychomycoses that affected the lesser toes only. As the management of onychomycoses is a complex procedure involving the exact diagnosis with a determination of the pathogenic fungus, the nail growth rate, the type of onychomycosis, its duration, and predisposing factors, anomalies of the toe position may be important. Among the most commonly mentioned predisposing factors are peripheral circulatory insufficiency, venous stasis, peripheral neuropathy, immune deficiency, and iatrogenic immunosuppression, whereas foot problems are not given enough attention. Unfortunately, many of these predisposing and aggravating factors are difficult to treat or correct. Generally, when explaining the treatment of onychomycoses to patients, the importance of these orthopedic alterations is not or only insufficiently discussed. In view of the problems encountered with the treatment of toenail mycoses, this attitude should be changed in order to make the patient understand why there is such a low cure rate despite excellent minimal inhibitory drug concentrations in the laboratory. [ABSTRACT FROM AUTHOR]

Background: Ingrown toenails are a common pathology. Although a range of conservative and surgical measures are widely used for this condition, little is known about their use in practice. This study explored current practice relating to the treatment or management of ingrown toenails by podiatrists in the UK. Methods: A cross‐sectional online survey (Qualtrics, Provo, UT, USA) conducted between March to June 2020 was distributed to practicing podiatrists treating or managing ingrown toenails in the UK. Results: A total of 396 practicing podiatrists responded (60.1% based in the private sector). The majority (88.6%) performed nail surgery most commonly (54.3%) less than five a month. Nearly all (95%) only performed nail avulsion with or without chemical matrixectomy, universally using phenol (97.2%). Application time and number of applications varied but was most commonly applied three times (61.5%) for a total of 3 minutes (75%). Aftercare varied considerably between public and private sectors, with public sectors offering fewer follow‐up appointments. Conclusions: Although there is a variation in clinical practice throughout the treatment pathway, almost all respondents offered nail avulsion with phenol matrixectomy, whereas very few provided incisional nail surgery. This data provides the most comprehensive description of how UK podiatrists conduct nail surgery for onychocryptosis. [ABSTRACT FROM AUTHOR]

Introduction: Amorolfine 5% lacquer is an established topical treatment for fungal infection of the nails. The success of topical therapy for onychomycosis depends on whether the permeated drug concentration in the deep nail bed is retained above the effective antifungal minimum inhibitory concentration (MIC). We compared the penetration profile of amorolfine and a new topical formula of terbinafine in human mycotic toenails using matrix-assisted laser desorption ionization mass spectrometry imaging–Fourier transform ion cyclotron resonance (MALDI-FTICR) imaging. Methods: Amorolfine 5% lacquer and terbinafine 7.8% lacquer were applied to mycotic nails (n = 17); nail sections were prepared, and MALDI-FTICR analysis was performed. Based on the MICs of amorolfine and terbinafine needed to kill 90% (MIC90) of Trichophyton rubrum, the fold differences between the MIC90 and the antifungal concentrations in the nails (the multiplicity of the MIC90) were calculated overall and for the keratin-unbound fractions. Results: Both amorolfine and terbinafine penetrated the entire thickness of the nail. The mean concentration across the entire nail section 3 h following terbinafine treatment was 1414 μg/g of tissue (equivalent to 4.9 mM) compared with 780 μg/g (2.5 mM) following amorolfine treatment (not significantly different; p = 0.878). The median multiplicity of the MIC90 was significantly higher in amorolfine- than terbinafine-treated nails overall (191 vs. 48; p = 0.010) and for the keratin-unbound fractions only (7.4 vs. 0.8; p = 0.002). Conclusion: In this ex vivo study, MALDI-FTICR demonstrated that, although amorolfine 5% and terbinafine 7.8% had similar distribution profiles, both penetrating from the surface to the nail bed, the concentration of amorolfine in the nail was significantly higher than that of terbinafine relative to their respective MIC90 values. Clinical studies are required to determine whether these effects translate to a clinical difference in treatment success. [ABSTRACT FROM AUTHOR]

Introduction: Onychomycosis is a fungal infection of the nails that can be challenging to treat. Here, matrix-assisted laser desorption ionization–Fourier transform ion cyclotron resonance (MALDI-FTICR) imaging was applied to the quantitative analysis of the penetration profile of the antifungal compound, amorolfine, in human mycotic toenails. The amorolfine profile was compared with those of three other antifungals, ciclopirox, naftifine, and tioconazole. Methods: Antifungal compounds (amorolfine 5% lacquer, ciclopirox 8% lacquer, naftifine 1% solution, and tioconazole 28% solution) were applied to mycotic nails (n = 42). Nail sections were prepared, and MALDI-FTICR analysis was performed on the sections at a spatial resolution of 70 μm to compare the distribution profiles. Based on the minimum inhibitory concentrations of the four test compounds needed to kill 90% (MIC90) of the fungal organism, Trichophyton rubrum, the fold differences between the MIC90 and the antifungal concentrations in the nails (termed the multiplicity of the MIC90) were calculated for each. Results: The penetration profiles indicated higher concentrations of amorolfine and ciclopirox in the deeper layers of the nails 3 h after treatment, compared with naftifine and tioconazole. The mean concentrations across the entire nail sections at 3 h were significantly different among the four antifungals: amorolfine, 2.46 mM; ciclopirox, 0.95 mM; naftifine, 0.63 mM; and tioconazole, 1.36 mM (p = 0.016; n = 8 per compound). The median multiplicity of the MIC90 at 3 h was 191-fold for amorolfine, tenfold for ciclopirox, 52-fold for naftifine, and 208-fold for tioconazole. Conclusion: In this study, MALDI-FTICR was successfully applied to the quantitative analysis of antifungal distribution in human mycotic nails. The findings suggest that amorolfine penetrates deeper layers of the nail and accumulates at concentrations far exceeding the MIC needed to exert antimycotic activity. [ABSTRACT FROM AUTHOR]

Artisanal gold mining can release metallic elements in the environment that can result in occupational and environmental exposures. This pilot study aimed to assess exposure to metals and metalloids from fingernail and toenail samples in artisanal gold mine workers, inhabitants of a mining and non-mining village in Mali. As it can be particularly challenging to collect and transport biological samples from remote areas, nail sample collection was tested as a potential choice for multielement biomonitoring. A convenience sampling of 315 individuals was performed equally distributed in each location group (105 per location) and stratified by populational group (male adults, female adults, and people

This document provides a historical overview of the management of ingrown toenails, tracing its history from ancient times to the 19th century. It explores the evolution of bipedal locomotion and the significance of the great toe in walking. The article also examines the etymology of ingrown toenails and describes different types of the condition. It highlights the presence of ingrown toenails in ancient medical texts and the contributions of scholars from diverse cultures. The document concludes by mentioning the pioneering work of Durlacher in the 19th century, who identified improper nail cutting as the primary cause of ingrown toenails. The history of ingrown toenail treatment dates back to ancient times, with various remedies and techniques being attempted throughout history. Ancient Egyptian and Indian texts mention treatments such as hot water washing, knife drainage, medicated oil application, and thermocautery. In civilizations where shoes were worn, remedies included rubbing mixtures of alum and honey, fomentation, and surgical procedures involving knives, cautery, and scissors. The use of anesthesia in the mid-19th century revolutionized the treatment of ingrown toenails. Despite advancements, there is still ongoing debate about the best approach to treating this condition. The article provides a historical overview of ingrown toenail management, highlighting important events and advancements in the field, such as the use of lunar caustics, the introduction of anesthesia for ingrown toenail operations, and the development of various surgical techniques. It emphasizes the [Extracted from the article]

Background: Psoriatic patients may experience the coexistence of onychomycosis (OM). However, the evaluation of OM in psoriatics has been hindered by potential clinical differences from OM in non‐psoriatics. Objective: To assess and compare dermoscopic features between toenail OM in psoriatic and in non‐psoriatic patients. Patients and Methods: Between September 2020 and September 2023, dermoscopy was conducted on 183 affected toenails by OM in psoriatics and 232 affected toenails by OM in non‐psoriatics in two centres. The dermoscopic characteristics were compared using the Chi‐squared test. Results: Among toenail OM cases in psoriatic subjects, the most prevalent dermoscopic features included pitting (147/183, 80.33%) and subungual hyperkeratosis (118/183, 64.48%). Conversely, toenail OM in non‐psoriatics was characterized by subungual hyperkeratosis (175/232, 75.43%) and nail spikes (139/232, 59.91%). Comparative analysis revealed a significantly higher occurrence of pitting (80.33% vs. 15.96%, p <.001), periungual telangiectasis (22.40% vs. 4.74%, p <.001), oil patches (12.57% vs. 0.43%,p <.001) and transverse grooves (43.72% vs. 28.45%,p <.01) in toenail OM in psoriatics. Furthermore, toenail OM in psoriatics exhibited a significantly lower frequency of yellow structureless area (13.11% vs. 42.67%, p <.001), nail spikes (43.17% vs. 59.91%, p <.01), ruin appearance of sulphur nugget (8.20% vs. 31.03%, p <.001), dotted/blocky haemorrhage (6.01% vs. 20.69%,p <.001) and partial onycholysis (32.79% vs. 46.98%, p <.01). Conclusions: Dermoscopic features of toenail OM in psoriatic and non‐psoriatic patients exhibit notable differences. OM in psoriatics shows a higher frequency of pitting and periungual telangiectasis, while a lower frequency of yellow structureless areas and nail spikes under dermoscopy. [ABSTRACT FROM AUTHOR]

Paronychia is a prevalent clinical disease affecting the soft tissue surrounding the nails. Most cases of toenail paronychia are commonly associated with ingrown toenails. While conservative treatment is effective for mild cases of ingrown toenails, surgical intervention becomes necessary for moderate to severe cases, particularly when granulomas form. To provide a systematic understanding of these classic and modified procedures for surgeons to select the appropriate surgical interventions for patients suffering from moderate to severe ingrown toenails and discuss this technology's advantages and limitations for dermatologic surgery. A literature search was performed using PubMed/MEDLINE and Google Scholar databases. Studies discussing surgical intervention for ingrown toenails were included. Moreover, the surgical steps were meticulously depicted by detailed schematic diagrams. These surgical techniques can be divided into three categories: matrix resection, debulking of periungual soft tissues, and the rotational flap technique. Each approach possesses distinct advantages and limitations. For moderate to severe cases, surgical interventions may exhibit superior outcomes, faster recovery times, and lower recurrence rates. The surgeon must possess a comprehensive understanding and proficient skillset in various surgical techniques for ingrown toenails. [ABSTRACT FROM AUTHOR]

Background: Fluoridation of public water systems is known as a safe and effective strategy for preventing dental caries based on evidence from non-randomized studies. Yet 110 million Americans do not have access to a fluoridated public water system and many others do not drink tap water. This article describes the study protocol for the first randomized controlled trial (RCT) of fluoridated water that assesses its potential dental caries preventive efficacy when delivered in bottles. Methods: waterBEST is a phase 2b proof-of-concept, randomized, quadruple-masked, placebo-controlled, parallel-group trial designed to estimate the potential efficacy of fluoridated versus non-fluoridated bottled water to prevent dental caries incidence in the first 4 years of life. Two hundred children living in eastern North Carolina, USA, and aged 2–6 months at screening are being allocated at random in a 1:1 ratio to receive fluoridated (0.7 mg/L F) or non-fluoridated bottled water sourced from two local public water systems. Throughout the 3.5-year intervention, study water is delivered monthly in 5-gallon bottles to each child's home with instructions to use it whenever the child consumes water as a beverage or in food preparation. Parents are interviewed quarterly to monitor children's water consumption and health. At annual visits, the presence of dental caries is evaluated with a dental screening examination. Clippings from fingernails and toenails are collected to quantify fluoride content as a biomarker of total fluoride intake. The primary endpoint is the number of primary tooth surfaces decayed, missing, or filled due to dental caries measured by the study dentist near the time of the child's fourth birthday. Tooth decay is assessed at the threshold of macroscopic enamel loss. For the primary aim, a least-squares, generalized linear model will estimate efficacy and its one-tailed, upper 80% confidence limit. Discussion: waterBEST is the first evaluation of a randomized intervention of fluoridated drinking water in bottles to prevent dental caries in the primary dentition. This innovative method of delivering fluoridated water has the potential to prevent early childhood caries in a large segment of the US population that currently does not benefit from fluoridated public water. Trial registration: ClinicalTrials.gov NCT04893681. Registered on March 2022. Last update posted on 10 October 2023. https://clinicaltrials.gov/study/NCT04893681?cond=Dental%20Caries%20in%20Children&term=fluoride&locStr=North%20Carolina,%20USA&country=United%20States&state=North%20Carolina&distance=50&rank=1 [ABSTRACT FROM AUTHOR]

Background Ingrown toenail is a common condition that results in chronic pain, recurrent infections, and difficulty in performing daily activities. Our aim is to compare two surgical methods for the treatment of ingrown toenails: wedge resection with curetting versus wedge resection curetting followed by electrocauterization of the nail bed. Methods A prospective, comparative study that included 130 patients with ingrown toenails. All patients had stage II or III disease. We divided the participants into two groups according to the type of surgery and all patients were followed up for 6 months. The outcomes measured were the incidence of postoperative bleeding and infection, recovery time, patient satisfaction, and recurrence rate 6 months after surgery. Results Of the 130 patients included, 59 (45.4%) underwent excision and curetting of the nail matrix (group 1) and 71 (54.6%) underwent excision, curetting, and electrocauterization of the nail matrix (group 2). The postoperative infection rates were 20.3 and 4.2% in the first and second groups, respectively (p = 0.004). Patient satisfaction was 76.3% among the first group, while 91.5% of patients in the second group were satisfied with the results of surgery. Six months postoperatively, recurrence rates were 25.4 and 4.2% in the first and second groups, respectively (p = 0.001). Conclusion Wedge excision and curettage, followed by electrocauterization of the ingrown toenail is a safe treatment modality with a high success rate, that is evident by a lower recurrence rate, and greater patient satisfaction, with no effect on postoperative pain score or recovery time. [ABSTRACT FROM AUTHOR]

Background: Onychomycoses are difficult‐to‐treat fungal infections with high relapse rates. Combining oral and topical antifungal drugs is associated with higher success rates. Additive or synergistic modes of action are expected to enhance treatment success rates. Objectives: Investigation of the combined effects of antifungal drugs in vitro with different modes of action and application on clinical isolates from mycotic nails. Methods: Isolates of Trichophyton rubrum, Trichophyton interdigitale and Scopulariopsis brevicaulis were collected from infected toenail specimens of patients with onychomycosis. Susceptibility testing was performed in 96‐well polystyrene plates using a standard stepwise microdilution protocol. Additive or synergistic activity at varying concentrations was investigated by the checkerboard method. Results: Combining terbinafine with amorolfine tended to be more effective than terbinafine in conjunction with ciclopirox. In most combinations, additive effects were observed. Synergy was detected in combinations with involving amorolfine in S. brevicaulis. These additive and synergistic interactions indicate that combined therapy with topical amorolfine and oral terbinafine is justified. Sublimation of amorolfine (and terbinafine) may enhance the penetration in and through the nail plate, and support treatment efficacy. Conclusions: These in vitro results support the notion that combining oral terbinafine and topical amorolfine is beneficial to patients with onychomycosis, particularly if the pathogen is a non‐dermatophyte fungus such as S. brevicaulis. [ABSTRACT FROM AUTHOR]

BACKGROUND: To date, there is no formal consensus on how to treat ingrown toenails. Despite the risk of causing irreparable damage to the nail, highly invasive procedures are still common. Less-invasive, matrix-directed techniques with shorter downtime and high cure rates exist, but, perhaps because of a lack of awareness, appear not to have been universally adopted. OBJECTIVE: The authors' study sought to generate data on common practices in the treatment of ingrown toenails. MATERIALS AND METHODS: The authors developed and conducted an online survey to ask dermatologists/ dermatosurgeons how they would proceed in 9 different cases of ingrown toenails based on photographs. RESULTS: The authors received 154 replies. Nonsurgical interventions, including advice on nail care/foot baths/ ointments/wraps/padding, were always the most frequently chosen option. Removal of the lateral nail plate followed by chemical partial matricectomy (phenolization) was the most or second-most frequently chosen surgical intervention. The answers were highly heterogeneous, and there was no unanimity based on morphology alone. CONCLUSION: Except for a preference for nonsurgical interventions, the authors could not identify any clear treatment standards. The heterogeneity of treatment approaches suggests the need for a guideline. [ABSTRACT FROM AUTHOR]

Background: Data on nail psoriasis (PsO) in China are scarce. Objectives: To provide nail PsO‐related data regarding epidemiologic characteristics, manifestations, fungal infections, arthritic complaints and treatments that may facilitate improved patient management globally. Methods: From August 2021 to August 2022, patients with nail PsO were enrolled in a prospective multicentre observational study at 25 hospitals in China. We collected and analysed data concerning nail PsO demography, clinical signs, fungal detection, arthritic symptoms and treatment. Results: A total of 817 patients with nail PsO were involved, with a mean body mass index of 24.13 ± 2.93. In addition, 71.41% of the patients were male. The Nail PsO Severity Index score was weakly positively correlated with body surface area. The percentage of nail involvement was 95.29% for fingernails and 57.18% for toenails, with pitting (67.11%) and subungual hyperkeratosis (60.40%) being the most prevalent manifestations, respectively. Toenails showed a significantly higher frequency of nailfold scales, subungual hyperkeratosis and nail plate crumbling and a lower frequency of splinter haemorrhages, pitting and erythema of the lunula. A total of 13.26% of the PsO patients had onychomycosis, and 77.08% were observed in the toenails. Articular symptoms were reported by 12.17% of the patients, with the peripheral type being predominant. Significant associations between articular symptoms and nailfold swelling, subungual hyperkeratosis, nailfold scales, onycholysis and longitudinal ridges were found. Only 2.30% (20 out of 871) of patients with nail PsO received treatment. The most frequently employed therapy for cutaneous PsO with nail involvement was biologic therapy (n = 366). Conclusions: PsO showed distinct manifestations in the toenails and fingernails. Additionally, toenail PsO combined with onychomycosis requires special attention. Articular symptoms in psoriatic patients are associated with specific nail changes. It is important to research and advocate for more potent treatments for nail PsO. [ABSTRACT FROM AUTHOR]

Ingrown toenails, clinically known as onychocryptosis, represent a prevalent nail pathology. The clinical manifestation involves symptoms typical for a foreign body reaction and in severe cases, tissue hypertrophy with complications may occur. Key risk factors include improper nail care, trauma, obesity, tight footwear, poor foot hygiene, and genetic predisposition. The condition predominantly affects individuals between the first and the third decades of life and older adults, with a predilection for the great toe, especially the lateral skin fold. The Heifetz and Scholz classifications delineate the stages of ingrown toenails based on severity. Therapeutic approaches range from conservative procedures, such as taping, dental floss, gutter treatment, cotton nail cast, braces and super elastic wire to surgical interventions like partial or total nail avulsion, matricectomy and advanced techniques like the Vandebos procedure or the Winograd procedure. Although many studies have analysed available treatment methods, there is no consensus among specialists regarding the best therapeutic strategy. Complications include paronychia, infection, and scarring. A comprehensive therapeutic approach should consider clinical severity, patient preferences, and both conservative and surgical interventions, emphasizing the importance of larger randomized clinical trials to establish definitive guidelines. Aim of this study: The current literature on epidemiology, risk factors, classification, complications and current therapeutic procedures in ingrown toenail was reviewed. In order to update knowledge about this disease entity. Material and methods: A systematic review of the scientific and medical literature from the PubMed and Google Scholar databases was carried out. [ABSTRACT FROM AUTHOR]

Hypotonia, Ataxia, Developmental Delay, and Tooth Enamel Defect Syndrome (HADDTS) is an exceptionally rare disorder resulting from a heterozygous variant in the C-terminal binding protein 1 (CTBP1) gene. To date, a mere two variants (14 patients) have been documented on a global scale. The aim of this study was to identify a causative CTBP1 variant in a Chinese patient, and to determine the potential pathogenicity of the identified variant. Here, Wholeexome sequencing (WES) was conducted on the proband to pinpoint the candidate variant. Following this, Sanger sequencing was employed to validate the identified candidate variant and examine its co-segregation within the available family members. Employing both in silico prediction and three-dimensional protein modeling, we conducted an analysis to assess the potential functional implications of the variant on the encoded protein. Our investigation led to the identification of a novel heterozygous variant in the CTBP1 gene, namely, c.371 C>T (p.Ser124Phe), in a Chinese patient. This case represents the first confirmed instance of such a variant in a Chinese patient. When comparing the patient's clinical symptoms with those reported in the literature, notable distinctions were observed between her primary symptoms and those associated with HADDTS. She showed other signs such as microcephaly, coarse facial features, single transverse palmar crease, visible beard, myopia, coarse toenail and skeletal anomalies. This study enriching the spectrum of genetic variants observed in different ethnic populations and expanding the phenotypic profile associated with this gene. These findings are expected to contribute to the enhancement of future variant-based screening and genetic diagnosis, while also providing further insights into the pathogenic mechanisms underlying CTBP1-related conditions. [ABSTRACT FROM AUTHOR]

Onychomycosis is an under-recognized healthcare burden. Despite the risk of misdiagnosis, confirmatory laboratory testing is under-utilized. Histopathologic examination with polymerase chain reaction (PCR) is currently the most effective diagnostic method; it offers direct detection and identification of a fungal invasion. In this retrospective cohort study, we assessed confirmatory testing results, with matching clinical diagnoses, in 96,293 nail specimens submitted during a 9-month period from 2022 to 2023. Toenail specimens were examined using fungal culture, histopathology and/or PCR. Clinical diagnoses were identified using the International Classification of Diseases 10th Revision codes. For clinically diagnosed onychomycosis patients, the overall positivity rate was 59.4%; a similar positivity rate (59.5%) was found in patients with clinically diagnosed non-fungal nail dystrophy. Performing a histopathologic examination with PCR was more likely to provide pathogen identification results than using fungal culture. Male patients had a higher rate of onychomycosis overall; however, female patients had more non-dermatophyte mold onychomycosis caused by Aspergillus. Clinically diagnosed onychomycosis patients with a co-diagnosis of tinea pedis were more likely to test positive for onychomycosis by PCR (odds ratio [OR]: 4.2; 95% confidence interval [CI]: 2.7–6.4), histopathology (OR: 2.5; 95% CI: 2.0–3.1) and fungal culture (OR: 3.2; 95% CI: 1.5–6.6). Our results support the use of confirmatory laboratory testing when there is a clinical diagnosis of onychomycosis. [ABSTRACT FROM AUTHOR]

Background: Toenail onychomycosis affects approximately 6.7% of Canadians. Symptoms include nail discolouration/disfiguration and pain; psychosocial impacts contribute to reduced health-related quality-of-life. Comorbid diabetes increases the risk of complications and exacerbates burden. Treatment may include topical therapy and/or oral agents. Purpose: To understand toenail onychomycosis treatment preferences, and to quantify the impact of toenail onychomycosis, with or without diabetes, on patient well-being. Methods: Adults living in Canada with self-reported, physician-diagnosed, toenail onychomycosis were recruited online. A discrete choice experiment was used to quantify treatment preferences. Scenarios were randomized; data were analyzed using conditional logit regression. Health state utilities were estimated using the Health Utilities Index Mark 3®. Results were stratified by diabetes status and toenail onychomycosis severity; the Wilcoxon Rank Sum test was used to assess between-group utility differences. Results: Three-hundred thirteen participants with toenail onychomycosis were included (161 had comorbid diabetes; 61.3%, severe onychomycosis). The mean age was 57.7 years; 55.9% were male. Treatment attributes with statistically significant impacts on patient preferences were efficacy (odds ratio [OR],1.04; 95% confidence interval [CI], 1.02– 1.05 per 1% increased treatment success), administration method (one pill versus topical nail lacquer reference, 1.14; 1.04– 1.26; topical solution applicator versus reference: 1.15; 1.03– 1.29), severe adverse events (0.85; 0.80– 0.90 per 1% increased risk), and risk of potential pharmacodynamic (0.80; 0.76– 0.85) and alcohol (0.93; 0.88– 0.98) interactions; preferences were more pronounced for efficacy and avoiding severe adverse events among toenail onychomycosis patients with comorbid diabetes. The mean (95% CI) utility value was 0.73 (0.70– 0.75) overall, and statistically significantly lower (p=0.02) for toenail onychomycosis patients with diabetes (0.70; CI, 0.66– 0.73) than those without (0.76; CI, 0.72– 0.79). Conclusion: Among patients with toenail onychomycosis, the presence of diabetes was associated with differing treatment-related preferences. Utility values for patients with toenail onychomycosis represent a significant decline from full health that is exacerbated by comorbid diabetes. [ABSTRACT FROM AUTHOR]

Toenails are a common monitoring tool for arsenic exposure, but the risk of external contamination of toenails has cast doubt on its usefulness. The main objective of this study is to investigate the micro-distribution of arsenic through the dorsoventral plane of nail clippings to understand endogenous vs exogenous sources. We used laser-ablation inductively coupled plasma mass spectrometry to measure arsenic through a dorsoventral cross-section of the nail plate collected from reference (N = 17) and exposed individuals (N = 35). Our main results showed (1) bulk toenail concentrations measured using ICP-MS in this study ranged from 0.54 to 4.35 µg/g; (2) there was a double-hump pattern in arsenic concentrations, i.e., dorsal and ventral layers had higher arsenic than the inner layer; (3) the double-hump was more pronounced in the exposed group (ventral: 6.25 μg/g; inner: 0.75 μg/g; dorsal: 0.95 μg/g) than the reference group (ventral: 0.58 μg/g; inner: 0.15 μg/g; dorsal: 0.29 μg/g) on average; (4) the distribution was, in part, associated with different binding affinity of nail layers (i.e., ventral > dorsal > inner); (5) most individuals in the higher exposure group showed > 25% contamination in ventral and dorsal nail layers; and (6) there were no statistically significant correlations between LA-ICP-MS arsenic with either bulk toenail arsenic or urine arsenic from the same individuals. Our results on micro-distribution and binding affinity provide insight into the impact of external contamination on arsenic concentrations and show how LA-ICP-MS can access the protected inner nail layer to provide a more accurate result. [ABSTRACT FROM AUTHOR]

Background: Trichophyton rubrum and Trichophyton mentagrophytes variant interdigitalis are the most frequent etiologic agents of onychomycosis. Diagnosis of certainty requires mycological examination, which often results unfeasible. Objectives: The aim of our study is to describe pathogen specific dermoscopic features, allowing a differential diagnosis without the need for cultural examination, in order to prescribe the most appropriate treatment anyway. Patients and methods: We conducted an observational retrospective study on 54 patients with a culture proven diagnosis of distal subungual onychomycosis of the toenail, caused by Trichophyton rubrum or Trichophyton mentagrophytes variant interdigitalis. Using a videodermatoscope we collected data on nail colour (white, yellow, orange, brown, dark) and on dermoscopic patterns (aurora, spikes, jagged, ruin, linear edge, dots, striae). Results: Fifty-four patients, with a total of 72 nails, were eligible for this study. Analysing the association between discoloration of the nail plate and type of infection (T. rubrum or T. interdigitalis), no correlation turned out to be statistically significant. Instead, significant associations between spikes and T. rubrum infection and striae and infection from T. interdigitalis were identified. Finally, a 100% specificity was identified for white colour and ruin pattern for T. rubrum infection, and brown colour, jagged border and aurora pattern for T. interdigitalis. Conclusions: Trying to find relationships between specific pathogens and dermoscopic patterns, we found out an association between spikes and striae and T. rubrum and T. interdigitalis respectively. Further larger studies are however necessary to evaluate our preliminary findings. [ABSTRACT FROM AUTHOR]

Background: Methylene blue (MB) and flavin mononucleotide (FMN)-mediated photodynamic therapy (PDT) have demonstrated local antimicrobial effect, but no direct comparative study has been published so far for the treatment of toenail onychomycosis. Objectives: To directly compare the short and medium-term efficacy of MB versus FMN as photosensitizers in PDT for toenail onychomycosis by applying them in a 40% w/w urea cream in two different dye concentrations. Methods: Forty toenails with distal and lateral subungual moderate onychomycosis due to dermatophyte fungi were randomised to receive 10 weekly sessions of PDT mediated by four topical formulations including MB or FMN at two different concentrations: Group I: 0.1% w/w MB; Group II: 2% w/w MB; Group III: 0.1% w/w FMN; and Group IV: 2% w/w FMN. Photographs were used for onychomycosis severity index (OSI) estimation allowing clinical assessment at any point of the study. Microscopic and microbiological evaluations were carried out at baseline, 27- and 35-week followups. Side effects were recorded along with patient satisfaction. Results: At week 27, mycological cure rates were 60%, 30%, 50% and 40% and complete cure rates were 0%, 20%, 10% and 20%, for Groups I, II, III and IV respectively. At week 35, mycological cure rates were 70%, 70%, 70% and 60% and complete cure rates were 30%, 50%, 70% and 30%, for Groups I, II, III and IV respectively. All cream formulations were safe and patients were fairly satisfied. Conclusions: Results of the present work confirm PDT as a therapeutic alternative for onychomycosis. Although all cream formulations were safe and effective, with a good degree of satisfaction, higher cure rates were obtained with 2% w/w MB cream and 0.1% w/w FMN cream. [ABSTRACT FROM AUTHOR]

Background/Objectives: Favipiravir is an antiviral agent, recently used for COVID‐19 infections. Several reports associate favipiravir intake with Wood's lamp fluorescence of hair, nails, and sclera. The present study was designed to elucidate the positivity rates, and sites of favipiravir‐related fluorescence and to unravel the site‐specific changes in fluorescence positivity rates by a function of time past exposure. Methods: The study population comprised 50 patients and 50 control individuals. All patients in the patient group had received a full dose of favipiravir for COVID‐19 infection. Fifty volunteers served as the control group. Wood's lamp examination was performed in a completely darkened room, and the positivity rate, extent, pattern, and distribution of fluorescence were recorded. Results: Wood's light revealed fluorescence of the fingernails, toenails, sclera, and hair in 35 (70%), 35 (70%), 22 (44%), and 8 (16%) patients, respectively. No control individual tested positive by Wood's lamp. Statistical analysis revealed significant differences between patient and control groups in terms of Wood's light luminescence in the fingernails (p =.000), toenails (p =.000), sclera (p =.000) and hair (p =.003). Although fingernail, toenail, and hair fluorescence positivity rates declined or ceased at or after 91 days of favipiravir exposure, ocular fluorescence positivity rates were prolonged up to 188 days. Conclusions: These findings confirm that favipiravir may produce fluorescence of nails, sclera, and hair, detectable by Wood's light starting from the initial month and peaking at second‐ and third months following exposure to the medication. Although nail and hair fluorescence tend to abate after 3 months, ocular fluorescence may persist even longer than 6 months after cessation of the medication. [ABSTRACT FROM AUTHOR]

A novel adhesion method of a sensor to a fingernail is described. Wearable sensors can provide health insights to humans for a wide variety of benefits, such as continuous wellness monitoring and disease monitoring throughout a patient's daily life. While there are many locations to place these wearable sensors on the body, we will focus on the fingertip, one significant way that people interact with the world. Like artificial fingernails used for aesthetics, wearable healthcare sensors can be attached to the fingernail for short or long time periods with minimal irritation and disruption to daily life. In this study the structure and methods of healthcare sensors' attachment and removal have been explored to support (1) the sensor functional requirements, (2) biological and environmentally compatible solutions and (3) ease of attachment and removal for short- and long-term user applications. Initial fingernail sensors were attached using a thin adhesive layer of commonly available cosmetic nail glue. While this approach allowed for easy application and strong adhesion to the nail, the removal could expose the fingernail and finger to a commercially available cosmetic nail removal (acetone-based chemical) for extended times measured in minutes. Therefore, a novel structure and method were developed for rapid healthcare sensor attachment and removal in seconds, which supported both the sensor functional objectives and the biologically and environmentally safe use objectives. [ABSTRACT FROM AUTHOR]

Background: Seasonal patterns in measured exposure biomarkers can cause measurement error in epidemiological studies. There is little research about the seasonality of metals and trace elements when assessed in toenail samples. Adjusting for such patterns in models for estimating associations between long-term exposures and health outcomes can potentially improve precision and reduce bias. Objectives: Assess and describe seasonal patterns in toenail measurements of trace elements. Methods: The Sister Study enrolled women residing in the US, including Puerto Rico, whose sister had been diagnosed with breast cancer. At the time of enrollment, participants removed nail polish and collected their toenail clippings, which were cleaned before analysis. We considered the following elements: iron, vanadium, aluminum, chromium, manganese, cobalt, nickel, copper, zinc, arsenic, selenium, molybdenum, cadmium, tin, antimony, mercury, and lead. For two subsamples of the cohort, we fit trigonometric regression models with toenail element measures as the outcome, using sine and cosine functions of the collection day (transformed to an angle) to capture seasonal patterns. These models can estimate the amplitude and timing of the peaks in measures. We evaluated the evidence for a seasonal effect by comparing for each measured element the trigonometric model to a model that was constant across time. Results: There was a seasonal trend in toenail element concentration for iron, aluminum, vanadium, chromium, manganese, cobalt, arsenic, molybdenum, cadmium, tin, and lead, all of which peaked near mid-August. Seasonal patterns were concordant across two non-overlapping samples of women, analyzed in different labs. Discussion: Given the evidence supporting seasonal patterns for 11 of the 17 elements measured in toenails, correcting for seasonality of toenail levels of those trace elements in models estimating the association between those exposures and health outcomes is important. The basis for higher concentrations in toenails collected during the summer remains unknown.

Background: When performing nail surgery, clinicians must choose from a multitude of procedures and variations within each procedure. Much has been published to guide this decision making, but there are a lack of up to date robust systematic reviews to assess the totality of this evidence. Methods: Five databases (MEDLINE, Embase, CINAHL, Web of Science and CENTRAL) and two registers (Clinicaltrials.gov and ISRCTN) were searched to January 2022 for randomised trials evaluating the effects of a surgical intervention(s) for ingrown toenails. Two independent reviewers screened records, extracted data, assessed risk of bias and certainty of evidence. Data on co-primary outcomes of symptom relief and symptomatic regrowth were presented in our first paper. This paper presents data for the secondary outcomes and further discussion. Results: Of 3,928 records identified, 36 randomised trials were included in the systematic review. Healing time appears to be reduced with shorter application of phenol. A reduced healing time was also apparent was with the addition of curettage, although this may also increase the risk of post-operative bleeding and pain. Post operative bleeding was also reportedly lower in people who received local anaesthetic with epinephrine but no tourniquet. Use of phenol with nail bed excision may decrease the risk of infection. Lower pain scores were reported when using partial matrixectomy and surgical interventions with phenol. Shorter duration of pain was reported with phenolisation and wedge resection. Participant satisfaction was high overall. Conclusion: This second paper reports secondary outcomes from a robust systematic review of randomised trials on surgical treatment of ingrown toenails. Despite the large volume of clinical trials conducted on the topic, few clinical conclusions can be drawn due to the poor quality of these studies. Further high-quality clinical trials are needed to answer fundamental questions in the surgical treatment of ingrown toenails. [ABSTRACT FROM AUTHOR]

Background: An ingrown nail (IN—ingrowing nail) is a very troublesome condition that mainly affects the big toe in all age groups and involves the ingrowth of part of the nail plate into the soft periungual tissues, causing an inflammatory reaction, pain, and even a bacterial infection. As a result of the evolution of inflammation, highly vascularized and painful granulation tissue is formed, visible in the side walls, which causes difficulties in walking, while reducing the quality of life of patients in everyday functioning. The aim of the study was to evaluate the effectiveness of the VHO-Osthold® Perfect orthonyxic buckle while treating ingrown nails and its effect on the clinical picture of the nail apparatus. Methods: A prospective observational study was conducted on 39 patients with ingrown toenails in Scholz stage 3a–5b who underwent therapy with the use of a VHO-Osthold® Perfect orthonyxic brace. An original questionnaire form was used to assess the therapy, consisting of several parts concerning the type and stage of the ingrown nails, the location and aetiopathogenesis of the ingrown nails, pain, and the patients' life quality before and after therapy. Results: All elements improved significantly after treatment (p < 0.05 each). Twelve months after the end of therapy, none of the probands reported disease relapse. The predominant location of ingrown nails was both big toes (69.2% for each foot). The most common group of reasons was outer pressure—all patients experienced at least one issue, with frequent mechanical injuries being the most common (59.0%), followed by wearing too-small shoes (46.2%). Almost half of the patients declared no worries during treatment (48.7%). Life quality assessment grew from 1.82 ± 1.02 to 6.41 ± 0.72 on a scale from 1 to 7, p < 0.001. Conclusions: The VHO-Osthold® Perfect clamp eliminates pain after application to the ingrown toenail and allows for a safe and conservative approach to the treatment of ingrown toenails, improving the clinical picture of the nail apparatus, general well-being, and the quality of life of patients with advanced ingrown toenails. [ABSTRACT FROM AUTHOR]

Objective: Composite tissue loss involving the distal finger pulp and the nail is a common but challenging finger injury to restore. This study introduces a reconstruction procedure for a distal finger pulp and nail defect using a partial toenail flap transfer. Methods: Twenty digits, including 16 thumbs, two index fingers, and two middle fingers, with composite soft tissue defects were treated with a partial toenail flap transfer from October 2015 to January 2020. Shortening revision of the great toe phalanx, a V‐Y advancement flap of the toe pulp, and a local pedicle flap from a second toe transfer were used to cover the donor sites, and no skin grafts were required. Functionality was evaluated using the validated Spanish version of the Quick‐DASH scale. The aesthetics of both the reconstructed and donor sites were evaluated using the Vancouver Scar Scale (VSS). The static two‐point discrimination (2‐PD) of the finger pulp was used as a measure of tactile agnosia. Results: All donor site wounds healed well. The average follow‐up time was 23.6 months (6–39 months). The mean Quick‐DASH functional score was 7.1. The VSS scores were 4.02 ± 0.29 and 4.00 ± 0.38 for the reconstructed and donor sites, respectively. The static 2‐PD of finger pulp was 4.5 ± 0.76 mm. The patients were satisfied with finger motion, sensory function, and aesthetic contour. Conclusions: Partial toenail flap transfer is the recommended treatment to regain motion, sensation, function, and a satisfactory aesthetic appearance when considering repairing a composite soft tissue distal finger defect with accompanying loss of the perionychium, particularly in the thumb, index finger, or middle finger. [ABSTRACT FROM AUTHOR]

Onychomycosis is a fungal infection of the nail unit affecting approximately five percent of the global population and representing 50 percent of all nail dystrophies seen in clinical practice. Patients with onychomycosis can suffer significant pain in addition to physical and psychological distress, which may seriously impair their quality of life (QoL). It is well established that onychomycosis prevalence is impacted by patient characteristics, including age and systemic comorbidities. However, the impact of patient sex on onychomycosis occurrence and treatment is not well characterized. This narrative review of the literature was conducted to address a dearth of published information on epidemiology, QoL, clinical trial participation, and treatment success specifically in female patients with onychomycosis. Additionally, an analysis of real-world treatment of onychomycosis in female patients is reported, including prescription patterns and the impact of toenail polish on topical treatments for onychomycosis. Understanding sex as a clinically relevant variable may inform onychomycosis treatment strategies and improve treatment outcomes. [ABSTRACT FROM AUTHOR]

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To design a comprehensive new PROM (NAIL-Q) to measure outcomes important in toenail and fingernail conditions.Methods: A mixed methods iterative approach was used. Phase 1 involved concept elicitation interviews that were audio-recorded, transcribed, and coded line-by-line. Concepts were developed into scales and refined through cognitive debriefing interviews with patients and expert input. Data was then collected from an international sample using a crowdsource platform. Eligible participants were aged ≥ 18 years with a nail condition for at least 3 months. Rasch Measurement Theory (RMT) analysis was used to examine item and scale performance. Other psychometric tests included test–retest reliability, and convergent and construct validity.Results: Phase 1 interviews involved 23 patients with 10 nail conditions and input from 11 dermatologists. The analysis led to the development of 84 items for field-testing. In Phase 2, 555 participants completed the survey. Toenail conditions (n = 441) were more common than fingernail conditions (n = 186). The RMT analysis reduced the number of items tested to 45 in 7 scales measuring nail appearance, health-related quality of life concerns, and treatment outcomes. All items had ordered thresholds and nonsignificant chi-square p values. Reliability statistics with and without extremes for the Person Separation Index were ≥ 0.79 and Cronbach's alpha were ≥ 0.83, and for intraclass correlation coefficients were ≥ 0.81. Construct validity was further supported in that most participants agreed that the NAIL-Q was easy to understand, asked relevant and important questions in a respectful way, and that it should be used to inform clinical care.Conclusion: The NAIL-Q is a rigorously designed and tested PROM that measures nail appearance, health-related quality of life and treatment outcomes. This PROM can be used in clinical practice to inform patient care and to include the patient perspective in research. [ABSTRACT FROM AUTHOR]

Silver compounds have been used in medicine to treat infections, open wounds, and chronic ulcers. Silver nitrate is used as a caustic, antiseptic, haemostatic and astringent agent. Using high-strength silver nitrate to treat the hypergranulation tissue complicating ingrown toenails is a customary practice by podiatrists in the United Kingdom. This study aims to identify what primary literature is available concerning the use of silver nitrate in this scenario, as anecdotal evidence suggests that its efficacy is limited. A scoping review of the literature was performed. The senior author searched electronic databases for primary studies and completed the independent screening process. The search identified 325 studies. After the rejection of those that were not relevant, a full-text review of 22 studies was performed. 21 studies were rejected as irrelevant, and one study was included. The second author then performed a free text search on Google and Google Scholar and found two further articles. In conclusion, this review found very little evidence to support the use of silver nitrate for treating the hypergranulation tissue affecting ingrown toenails. [ABSTRACT FROM AUTHOR]

Background: Toenails play a great part in protecting toes and peripheral soft tissues, simultaneously playing a cosmetic role. The ideal treatment should result in a functional and aesthetic outcome. Objective: To describe a novel, aesthetic and minimally invasive method to treat ingrown toenail. Methods: We retrospectively analyzed 436 lesions of 395 ingrown toes in 353 patients with a mean age of 26.0 ± 13.4 (range 10–55) from June 2014 to March 2020 in our department. A novel cosmetic approach for partial matricectomy in treating ingrown toenails was undergone. The average follow‐up time was 27.5 ± 2.8 months. The average period prior to work resumption, recurrence rate, and infection rate were measured. Mean pain Visual Analogue Scale (VAS) and Mean satisfaction VAS were used to evaluate the foot appearance. Results: The average period prior work resumption was 2.2 ± 2.1 days (range, 0–7 days). The recurrence rate was 1.6% (7 lesions in 6 patients) at more than 2 years of follow‐up. There was no critical complication except infection (0.46%). Mean pain VAS reduced from a preoperative score of 7.7 ± 1.5 points (range, 6–10 points) to a postoperative 3‐day score of 2.2 ± 1.0 points (range, 1–4 points; p < 0.001) while Mean satisfaction VAS improved from 1.5 ± 1.3 points (range, 0–3 points) to 9.2 ± 0.6 points (range, 8–10 points; p < 0.001). Conclusion: Our proposed approach is minimally invasive relative to conventional methods, which can achieve comparable efficacy to treat ingrown toenails with granulation tissue. Therefore, it can serve as another option to treat this specific type of ingrown toenails. [ABSTRACT FROM AUTHOR]

A73-year-old woman presented with a nail abnormality. She first noticed the condition several months earlier in her toenails, and then it also developed in her fingernails. The patient had no history of similar nail issues. She had previously seen a dermatologist for this condition, and a potassium hydroxide preparation showed no hyphae. [ABSTRACT FROM AUTHOR]

A sympathetic crashing pulmonary edema (SCAPE) is an emergency medical situation necessitating early recognition and treatment. We present a case of a 15-years old male who underwent a toenail excision of his left big toe and who developed SCAPE postoperatively. The low incidence of SCAPE intraoperatively makes it challenging for anesthesiologists to diagnose it. It occurs unexpectedly and precipitously, and it may increase the risks of morbidity and mortality if it is not treated promptly. Our aim is to raise awareness of how to abruptly manage such cases. [ABSTRACT FROM AUTHOR]

Introduction: How to reconstruct the damaged fingertip is a clinical problem. Our team propose the theory of equivalent design and use the mini toenail flap pedicled with the hallux transverse artery and toe pulp vein transplantation technique to reconstruct Allen's type II fingertip injury. Thus, we perform the retrospective study to evaluate the effects of this technique on fingertip injury. Materials and methods: A retrospective analysis was performed on 56 patients admitted to our hospital from January 2015 to January 2020 who used equivalently designed miniature hallux toenail flaps for the plastic repair of fingertip damage. We recorded the size of the miniature hallux toenail flap, operation time, intraoperative blood loss, and complications and calculated the survival rate of the transplanted miniature hallux toenail flap. During routine follow-up after surgery, we recorded nail growth time and observed finger appearance. At the last time of follow-up, we recorded Semmes-Weinstein evaluating tactile sensation and Two-point discrimination testing (TPD). The efficacy was evaluated by Zook score evaluation. Results: The size of the mini hallux toenail flap was 0.71 cm × 1.22 cm to 0.88 cm × 1.71 cm. The operation time was (3.54 ± 0.58) hours, the intraoperative blood loss was (20.66 ± 4.87) ml, and the survival rate of mini hallux toenail flaps was 100%. The postoperative follow-up time was (30.82 ± 11.21) months, and the total nail growth time was (9.68 ± 2.11) months. The average tactile sensation evaluated by the Semmes-Weinstein test was (0.32 ± 0.14) g, and the average TPD was (7.33 ± 1.02) mm. According to Zook score, the curative effect of fifty-six cases were all excellent or good with 100% excellent and good rate, and all patients had beautiful appearances and good function of damaged fingertips. Conclusions: Based on the equivalent design theory, the mini hallux toenail flap pedicled with the hallux transverse artery and toe pulp vein transplantation technique is an effective method to reconstruct Allen's type II fingertip injury with a beautiful appearance and good function. Type of study/level of evidence: Therapeutic IV. [ABSTRACT FROM AUTHOR]

BACKGROUND: Intramedullary nail is a classical scheme for the treatment of femoral shaft fracture. Its distal aiming frame is widely used in the placement of distal locking nail, which improves the accuracy of distal locking nail placement, but its failure rate cannot be ignored. It is urgent to develop a new technology that can actualize the rapid and accurate locking of distal locking nail and reduce the X-ray radiation damage of bare-handed locking nail. OBJECTIVE: To compare the effect of place-occupying compression rod technique and bare-hand locking nail technique in distal locking nail placement of femoral intramedullary nail. METHODS: The eight model bones with the deviation of the compression rod that could not be accurately placed into the distal locking nail were divided into two groups. The place-occupying compression rod group (n=4) adopted the place-occupying compression rod technology. After drilling the hole adjacent to the original pressure rod hole, the accurate pressing rod was carried out, and then the distal locking nail placement carried on. In the bare-hand locking nail group (n=4), the technique of bare-hand nail under the supervision of C-arm was used to complete the placement of locking nail in the distal locking hole. The X-ray exposure times, nail locking time and nail placement accuracy were compared between the two groups. RESULTS AND CONCLUSION: (1) The number of X-ray exposure in the place-occupying compression rod group was significantly less than that in the bare-hand locking nail group (P < 0.05). The time of locking nail in the place-occupying compression rod group was significantly shorter than that in the bare-hand locking nail group (P < 0.05). The accuracy of nail placement in both groups was 100%. (2) The results showed that the technique of place-occupying compression rod and the technique of bare-hand locking nail could complete the placement of distal locking nail accurately, and the technique of place-occupying compression rod has the advantages of shorter operation time and less X-ray radiation compared with the technique of bare-hand locking nail. [ABSTRACT FROM AUTHOR]

Background: A new water‐soluble formulation with ciclopirox has shown a higher penetration than other ciclopirox nail lacquers currently marketed, thus providing a higher concentration of ciclopirox into the nail. Objective: To evaluate the efficacy and safety of a new ciclopirox nail hydrolacquer compared with its vehicle and an active comparator (hydroxypropyl chitosan‐based 80 mg/g ciclopirox nail lacquer) for the treatment of toenail fungal infection. Methods: Phase III, multicenter, randomised, double‐blind, clinical trial in patients with distal mild to moderate toenail onychomycosis due to dermatophyte fungi. Patients were randomised to apply topically a ciclopirox nail hydrolacquer, its vehicle or a reference product once daily for 48 weeks with a follow‐up period of 4 weeks up to week 52. Results: A total of 381 patients were included. No statistically significant differences were observed between patient groups in the proportion of subjects achieving a complete cure. At week 52, a higher percentage of patients in the ciclopirox nail hydrolacquer group achieved a mycological cure (negative for culture and DTS/KOH test, with results: 32.0% ciclopirox nail hydrolacquer, 23.2% vehicle and 27% reference product, respectively), and similar results were found for improvement (mycological cure and reduction of diseased nail ≥20%, with results: 27.2% ciclopirox nail hydrolacquer, 21.6% vehicle and 20.6% reference product, respectively). Regarding mycological results, only ciclopirox nail hydrolacquer demonstrated significant statistical superiority versus vehicle negativizing dermatophyte culture (p =.039) with no recurrences, relapses or re‐infections in a four‐week follow‐up patients with complete cure. The safety profile was comparable to the vehicle and reference product and consistent with the previously reported. Conclusions: A new water‐soluble formulation for a ciclopirox nail lacquer showed similar efficacy to the reference product to eradicate toenail onychomycosis and superiority in the mycological cure defined by negative culture, thus preventing reinfections and recurrences. Efficacy and safety data demonstrate the positive benefit–risk profile of this new topical antifungal preparation. [Correction added on 13 April 2023, after first online publication: The results and conclusions in the Abstract contained incorrect information and were revised in this version.] [ABSTRACT FROM AUTHOR]

Diabetes Mellitus (DM) is a risk factor for fungal infections, including onychomycosis. The study aims to determine the prevalence of toenail onychomycosis in diabetic patients and its correlation with associated factors, identify the causative agents and compare the fungal culture findings with the real-time polymerase chain reaction (RT-PCR) findings of diagnosing 6 fungal isolates. A total of 126 diabetic patients were included between November 2020 to June 2021. Nail samples were subjected to potassium hydroxide 20%. Culture was done on Sabouraud dextrose agar medium (SDA), both with and without cycloheximide. Identification of non-dermatophytic molds was based on colony characteristics, colony reverse, cellotape flag method and slide culture technique. Molecular analysis was done to make sure of the identification of 6 fungal isolates. Out of 126 cases, 106 (84.1%) had toenails onychomycosis. Non-dermatophytic molds (NDM) were the most common isolates 75 (70.8%), followed by yeasts 8 (7.5%) and mixed infections 23 (21.7%). Distal lateral subungual onychomycosis (DLSO) was the most frequent clinical type 90 (85%). Onychomycosis was found to correlate significantly with advancing age, type 2 diabetes, its duration and clinically abnormal nails. However, there was no significant correlation with gender and glycosylated hemoglobin (HbA1C). When the results obtained by RT-PCR were compared with the results obtained by fungal culture, a 100% match of the isolates was found. [ABSTRACT FROM AUTHOR]

Background There is a paucity of evidence regarding the relative therapeutic efficacy of treatments for onychomycosis. Objectives We determined the relative efficacy of monotherapies for dermatophyte toenail onychomycosis with Bayesian network meta-analyses (NMAs). Methods We searched PubMed, Scopus, EMBASE (Ovid) and CINAHL to identify studies that investigated the efficacy of monotherapy with oral antifungals for dermatophyte toenail onychomycosis in adults. In this paper, 'regimen' corresponds to a given agent and its dosage. The relative effects and surface under the cumulative ranking curve (SUCRA) values of the various regimens were estimated; evidence quality was assessed at the study level and across networks. Results Data from 21 studies were used. Our two efficacy-related endpoints were: (i) mycological and (ii) complete cure at 1 year; safety--related endpoints were: (i) 1-year count of any adverse event (AE), (ii) 1-year odds of discontinuation due to any AE, (iii) 1-year odds of discontinuation due to liver issues. Thirty-five regimens were identified; the newer agents among these included posaconazole and oteseconazole. We compared the efficacy of newer regimens with traditional ones like 'terbinafine 250 mg daily for 12 weeks' and 'itraconazole 200 mg daily for 12 weeks. We found that an agent's dosage was associated with its efficacy; for example, the 1-year odds of mycological cure with terbinafine 250 mg daily for 24 weeks (SUCRA = 92.4%) were significantly greater than those of terbinafine 250 mg daily for 12 weeks (SUCRA = 66.3%) (odds ratio 2.62, 95% credible interval 1.57–4.54). We also found that booster regimens can increase efficacy. Our results showed that some triazoles could be more effective than terbinafine. Conclusions This is the first NMA study of monotherapeutic antifungals – and their various dosages – for dermatophyte toenail onychomycosis. Our findings could provide guidance for the selection of the most appropriate antifungal agent, especially amid the growing concerns about terbinafine resistance. [ABSTRACT FROM AUTHOR]